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Saudi Journal of Kidney Diseases and Transplantation
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   2016| January-February  | Volume 27 | Issue 1  
    Online since January 15, 2016

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Coping strategies and socio-demographic characteristics among Jordanian caregivers of patients receiving hemodialysis
Eman Alnazly
January-February 2016, 27(1):101-106
DOI:10.4103/1319-2442.174088  PMID:26787574
Individuals who care for family members receiving chronic hemodialysis (HD) are likely to experience burdens that may adversely impact their patients. Effective coping strategies are shaped by various factors, including sociodemographic characteristics. To assess the relationship between caregivers and their patients, we studied 225 family-member caregivers of chronic HD patients through answering the Ways of Coping Questionnaire-Revised. Sociodemographic data, including caregiver age, gender, educational level, relationship to the patients, length of care time and weekly hours of caregiving were analyzed using the t-test, analysis of variance and least-significant difference post hoc test. Of the eight coping strategies investigated, seven were significantly related to at least one of the analyzed sociodemographic variables; these were confrontive coping, distancing, self-controlling, seeking social support, accepting responsibility, planful problem solving and positive reappraisal. The findings of the present study may be useful for administering dialysis by nurses for identifying coping strategies among caregivers and for establishing plans of care that would promote coping strategies in relation to the caregiver's sociodemographic characteristics.
  10 5,912 728
Erectile dysfunction in hemodialysis patients
Imen Gorsane, Nadia Amri, Fathi Younsi, Imed Helal, Adel Kheder
January-February 2016, 27(1):23-28
DOI:10.4103/1319-2442.174057  PMID:26787562
Erectile dysfunction (ED) is a common problem seen among patients on hemodialysis (HD), but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5%) and diabetes (41.6%). The prevalence of ED was 80%, including 33.3% severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH), follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4% of patients before the discovery of renal failure and in 91.6% of patients at the beginning of dialysis. For 19 patients (79.1%), the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life.
  9 5,236 747
Amelioration of cisplatin-induced nephrotoxicity by ethanolic extract of Bauhinia purpurea: An in vivo study in rats
Md Azmat Rana, Rahat Ali Khan, Mohammad Nasiruddin, Aijaz Ahmed Khan
January-February 2016, 27(1):41-48
DOI:10.4103/1319-2442.174068  PMID:26787565
Our objective is to study the nephroprotective activity and antioxidant potential of Bauhinia purpurea unripe pods and bark against cisplatin-induced nephrotoxicity. Healthy adult albino rats of either sex (150-200 g) were randomly divided into six groups of six animals each Group I (vehicle control) and Group II (negative control). Group III (BBE200) and Group IV (BBE400) were administered the ethanolic extract of Bauhinia purpurea bark in doses of 200 and 400 mg/kg/day p.o., respectively, and Group V (BPE200) and Group VI (BPE400) were administered the ethanolic extract of Bauhinia purpurea unripe pods at doses of 200 and 400 mg/kg/day p.o., respectively. All the treatments were given for nine days. Cisplatin in a single dose of 6 mg/kg i.p. was given on the 4 th day to all groups, except the vehicle control group. On the 10 th day, blood and urine were collected for biochemical tests and the rats were sacrificed. The kidney was removed for histology and lipid peroxidation-antioxidant test. Cisplatin caused nephrotoxicity as evidenced by elevated blood urea, serum creatinine and urine glucose, and there was decreased creatinine clearance in Group II as compared with Group I. Administration of BBE and BPE at doses of 200 and 400 mg/kg in Group III and Group VI caused a dose-dependant reduction in the rise of blood urea, serum creatinine and urine glucose, and there was a dosedependant increase in creatinine clearance compared with Group II. There was increased catalase and glutathione and decreased malondialdehyde levels in Group II, while BBE 400 (Group IV) and BPE 400 (Group VI) treatments significantly reversed the changes toward normal values. Histological examination of the kidney revealed protection in Group IV and Group VI compared with Group II. The ethanolic extract of Bauhinia purpurea unripe pods and bark has a nephroprotective activity against cisplatin-induced nephrotoxicity in rats.
  9 3,869 509
Epidemiology and risk factors of chronic kidney disease in the El-Sharkia Governorate, Egypt
Tarek A Ghonemy, Salama E Farag, Sameh A Soliman, Amir El-okely, Yasser El-hendy
January-February 2016, 27(1):111-117
DOI:10.4103/1319-2442.174137  PMID:26787576
End-stage renal disease (ESRD) is increasing worldwide. Renal replacement therapy and kidney transplantation are increasing the burden on health systems. Various risk factors can lead to this disease. In this work, we tried to study the epidemiology and risk factors of chronic kidney diseases (CKDs) in one of the Egyptian areas (El-Sharkia Governorate), and from this study we can get some data about the distribution and most common causes of this disease. A cross-sectional study was conducted at 15 dialysis centers in governmental hospitals in ElSharkia, Egypt. We used a questionnaire and direct interviewing with ESRD patients in addition to using medical records for our data collections. One thousand and four patients were selected randomly from 2136 patients who were known CKD patients on regular hemodialysis. Each week, two to three visits were performed in each center and during each visit, direct interviews were performed for ten to 15 patients, which took about 30 min for each patient. The study sample (n = 1004 patients) consisted of 62.2% males and 37.8% females. The mean age of patients was 52.03 + 14.67 years. The highest percentage of patients (31.9%) was found to be between 50 and 60 years in both males and females. More than half (61.3%) of the ESRD patients were living in villages, while about one-third (38.7%) of the ESRD patients were living in cities. Hypertension and diabetes were the main causes of ESRD. 15.5% of ESRD patients had diabetes mellitus, 31.8% had hypertension, 8.4% had kidney stone, 8.8% had urinary tract infection, 4.6% had congenital abnormality and 3.7% had primary glomerulonephritis. The main risk factors of renal diseases are hypertension and diabetes, while unknown causes represent a high percentage of all causes by 17.7%. Primary glomerulonephritis is the lowest cause of CKD in the El-Sharkia governorate, Egypt.
  7 9,839 1,207
N-acetylcysteine and/or ascorbic acid versus placebo to prevent contrast-induced nephropathy in patients undergoing elective cardiac catheterization: The NAPCIN trial; A single-center, prospective, randomized trial
Mohammed Habib, Alaa Hillis, Amen Hammad
January-February 2016, 27(1):55-61
DOI:10.4103/1319-2442.174072  PMID:26787567
Several protective measures have been described to prevent contrast-induced nephropathy (CIN). This study is aimed to evaluate the effect of a high dose of N-acetylcysteine (NAC) plus hydration, a low dose of NAC plus ascorbic acid and hydration or hydration alone on the prevention of CIN in high-risk patients undergoing elective coronary artery intervention. We conducted a randomized, prospective, placebo-controlled trial of 105 high-risk patients undergoing elective cardiac catheterization. The patients were divided into three different groups: Group A (n = 30), NAC 1200 mg orally before angiography and 1200 mg orally twice daily for three doses along with good hydration; Group B (n = 30), NAC 600 mg before angiography and 600 mg orally twice daily for three doses plus ascorbic acid (3000 mg one dose) before angiography and 2000 mg two doses after angiography and good hydration; and Group C (n = 45), hydration with 0.9% saline started just before contrast media injection and continued for 12 h at a rate 1.0 mL/kg/min after angiography or 0.5 mL/kg/h in cases with overt heart failure for 12 h. CIN was defined as an increase in serum creatinine of >25% of baseline or an absolute increase of 0.5 mg/dL above baseline after 48 h. The incidence of CIN was significantly lower in Group A (6.66%) compared with Group B (16.66%) or Group C (17.77%). The difference between Groups A and B and between Groups A and C was also highly significant (P = 0.001). In contrast, the difference between Groups B and C was not statistically significant (P = 0.37). Our study indicates that high doses of NAC plus hydration provide better protection against CIN than combination therapy of NAC and ascorbic acid plus hydration, or hydration alone.
  6 5,969 1,116
Prevalence of calcified carotid artery atheromas on panoramic radiographs of renal stone patients
Santosh Patil, Sneha Maheshwari, Suneet Khandelwal, Ritumvada Malhotra, Anupam Desmukh
January-February 2016, 27(1):62-66
DOI:10.4103/1319-2442.174074  PMID:26787568
The aim of the present study was to evaluate the prevalence of calcified carotid artery atheromas detected on panoramic radiographs of patients with renal stones and to assess the correlation of renal stones and carotid artery calcifications (CAC). Panoramic radiographs of 120 renal stone patients (76 males and 44 females) and 120 controls (68 males and 52 females) were examined for any calcifications in the carotid artery. The mean age of the patients with renal stones and controls was 40.6 ± 7.8 years and 41.1 ± 6.7 years, respectively. A total of 25 (20.8%) patients with renal stones and 16 (12.3%) patients from the control group showed CAC. The calcifications were however higher in the patients with renal stones, but there was no statistically significant difference (P >0.05) between the two groups. CAC was found in 15 males and ten females with renal stones and nine males and seven females of the control group, and this difference was not statistically significant (P >0.05). In the present study, no significant relationship was found between the presence of CAC in the patients with renal stones and the control group. However, there was a trend for higher prevalence of CAC in renal stone patients.
  6 4,087 445
Knowledge, attitudes and beliefs of first-degree relatives of patients with chronic kidney disease toward kidney donation in Nigeria
Babawale T Bello, Yemi R Raji
January-February 2016, 27(1):118-124
DOI:10.4103/1319-2442.174141  PMID:26787577
In most parts of Sub-Saharan Africa, kidney transplant programs are dependent on the willingness of relatives of patients with kidney failure to donate kidneys. This study assessed the attitudes of relatives of patients with chronic kidney disease (CKD) toward kidney donation. This was a cross-sectional survey of relatives of patients with CKD attending the nephrology service of our hospital. The respondents' socio-demographic characteristics and knowledge and beliefs about kidney transplantation, as well as their willingness to donate a kidney, were assessed using a self-administered questionnaire. There were 161 respondents who returned completed questionnaires; the mean age of the respondents was 34.8 ± 12.6 years and 52.2% of them were female. About 85.1% of the respondents were aware that kidney transplantation was a treatment option for end-stage renal failure, while 70% of them believed that kidney transplantation resulted in an improvement in the quality of life of these patients. However, 25.5% of the respondents believed that kidney donors were at risk of developing kidney failure in the future. Overall, 77.6% of the respondents were willing to donate a kidney, especially if the affected individual was their offspring. The majority of the respondents were willing to donate a kidney to a relative with CKD.
  6 4,145 497
The effects of cinacalcet treatment on bone mineral metabolism, anemia parameters, left ventricular mass index and parathyroid gland volume in hemodialysis patients with severe secondary hyperparathyroidism
Dilek Torun, Ismail Yildiz, Hasan Micozkadioglu, Gul Nihal Nursal, Fatma Yigit, Ruya Ozelsancak
January-February 2016, 27(1):15-22
DOI:10.4103/1319-2442.174053  PMID:26787561
The aim of this study was to investigate the effects of cinacalcet therapy on anemia parameters, bone mineral metabolism, left ventricular mass index (LVMI) and parathyroid gland volume in hemodialysis (HD) patients with secondary hyperparathyroidism. Twenty-five HD patients (M/F: 11/14, mean age: 45.2 ± 17.9 years, mean HD duration: 96.4 ± 32.7 months) were included in this prospective pilot study. The indication to start calcimimetic therapy was persistent serum levels of parathyroid hormone (PTH) >1000 pg/mL, refractory to intravenous (i.v.) vitamin D and phosphate-binding therapy. The initial and one-year results of adjusted serum calcium (Ca +2 ), phosphate (P), Ca × P product, PTH, hemoglobin (Hb) and ferritin levels, transferrin saturation index (TSAT), median weekly erythropoietin (EPO) dose, LVMI, and parathyroid volume by parathyroid ultrasonography were determined. There were no differences between pre- and post-treatment levels of serum Ca +2 (P = 0.853), P (P = 0.447), Ca × P product (P = 0.587), PTH (P = 0.273), ferritin (P = 0.153) and TSAT (P = 0.104). After 1 year of calcimimetic therapy, the Hb levels were significantly higher than the initial levels (P = 0.048). The weekly dose of EPO decreased with no statistical significance. The dose of cinacalcet was increased from 32.4 ± 12.0 to 60.0 ± 24.4 mg/day (P = 0.01). There were no differences between the pre- and post-treatment results regarding weekly vitamin D dose, parenteral iron dose, LVMI and parathyroid volume. The results of our study suggest that cinacalcet therapy might have an additional benefit in the control anemia in HD patients.
  3 4,119 837
The predictive factors for relapses in children with steroid-sensitive nephrotic syndrome
Shatha Hussain Ali, Abdulkareem Mohammed Ali, Abbas Hindi Najim
January-February 2016, 27(1):67-72
DOI:10.4103/1319-2442.174075  PMID:26787569
Most patients with steroid-sensitive nephrotic syndrome (SSNS) have frequent relapses (FR); this is considered one of the main problems because of its association with a high incidence of complications. The aim of our study was to evaluate the different factors that might be associated with the occurrence of relapse in SSNS. This is a retrospective study of 80 patients with SSNS conducted at the Pediatric Nephrology Clinic in the Al-Kadhymia Teaching Hospital between January 2011 and November 2011. The study patients were divided into two groups: FR and infrequent relapses (IFR). The age of the study patients was between one and 14 years; 45 patients had FR (56.3%) and 35 patients had IFR (43.7%). Males constituted 55 patients (68.7%) and 25 patients were female (31.3%). The incidence of FR was high in all age-groups, except in the 1-5 years age-group, and was higher in children living in urban areas. There was no significant difference between the two groups in age, gender, place of residence and renal functions. However, there was a significant difference in the presence of hematuria, time taken to respond to therapy and duration of steroid therapy required; all were higher in the FR group. Our results will help clinicians in identifying possible FR such that they may be monitored closely.
  3 5,717 980
Mechanical complications of continuous ambulatory peritoneal dialysis: Experience at the Ibn Sina University Hospital
Kaoutar Flayou, Naima Ouzeddoun, Rabia Bayahia, Hakima Rhou, Loubna Benamar
January-February 2016, 27(1):107-110
DOI:10.4103/1319-2442.174089  PMID:26787575
Peritoneal dialysis is a new renal replacement therapy recently introduced in Morocco since 2006. Continuous ambulatory peritoneal dialysis has proven to be as effective as hemodialysis. However, it is associated with several complications. The aim of this study was to evaluate the outcome of complications in patients treated with peritoneal dialysis at our center. The nature of non-infectious complications was noted during follow-up in these patients. Fiftyseven complications were noted among 34 patients between June 2006 and June 2014. Catheter migration was the most common complication (36.8%), followed by obstruction (14%), dialysate leaks (14%), hemorrhagic complications (10.5%) and, finally, hernia (12.2%), catheter perforation (5.2%) and externalization (3.5%).
  3 5,168 612
A comparison of definitions of contrast-induced nephropathy in patients with normal serum creatinine
Mohammad Reza Khatami, Nasrin Nikravan, Mojtaba Salari-Far, Safieh Davoudi, Mohammad Reza Pahlavan-Sabbagh
January-February 2016, 27(1):94-100
DOI:10.4103/1319-2442.174086  PMID:26787573
Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury in hospitalized patients. The prevalence of CIN is reported to range from 0% to 50%, depending not only on patient condition and the procedure used but also the definition of CIN applied. We aimed to determine the best diagnostic indicator of CIN in patients with normal serum creatinine. This study included 206 patients with normal serum creatinine who underwent coronary angiography/angioplasty. Serum creatinine level and glomerular filtration rate (GFR) were measured before and on the second and fifth days after contrast administration. The incidence of CIN based on a 25% increase in serum creatinine was calculated and compared with the incidence based on a 25% decrease in GFR or an increase of at least 0.5 mg/dL in serum creatinine. Of 206 patients, 127 were male (61.7%) and 79 were female (38.3%); the mean age was 59.56 ± 10.3 years. The prevalence of CIN was 30% based on a 25% increase in serum creatinine, 23% based on a 25% decrease in GFR (P <0.012) and 3.8% based on a serum creatinine increase of at least 0.5 mg/dL (P <0.0001). The serum creatinine levels remained within the normal range in the majority of patients with CIN based on the different definitions. In patients with normal serum creatinine, the absolute increase in serum creatinine may describe the prevalence of CIN more accurately than the relative increase in serum creatinine or relative decrease in GFR.
  2 3,131 420
Evans syndrome and its link with systemic lupus erythematosus
Satish Mendonca, Sachin Srivastava, Rajan Kapoor, Devika Gupta, Pooja Gupta, ML Sharma
January-February 2016, 27(1):147-149
DOI:10.4103/1319-2442.174177  PMID:26787583
Evans syndrome is a rare syndrome associated with the presence of autoimmune hemolytic anemia and simultaneous or sequential development of thrombocytopenia. It was first described by Evan and Duane in 1951. It is one of the rare presenting features of autoimmune disorders, especially systemic lupus erythematosus (SLE), and sometimes may even precede the onset of disease. Primary Evans syndrome with no cause is very rare and is seen in children. Here, we describe a case of secondary Evans syndrome with severe hemolytic anemia leading to acute kidney injury and recovery thereafter only to develop lupus nephritis a few months later. This is one of the rare presentations of SLE and there are only anecdotal case reports.
  2 6,452 956
Evaluation and therapy in four patients with Takayasu's arteritis
S Conkar, S Mir, B Sözeri, Kaplan Bulut, C Çınar
January-February 2016, 27(1):164-169
DOI:10.4103/1319-2442.174205  PMID:26787588
Takayasu's arteritis (TA) is a large-vessel vasculitis primarily affecting the aorta and its branches. It ranks third among other types of childhood vasculitis, while it is the most common large vessel vasculitis observed in childhood. The diagnosis of TA should be made on the basis of clinical criteria and supported with laboratory findings, while confirming it with the imaging methods. Angioplasty, stent and bypass grafts may be necessary in the case of an irreversible arterial stenosis. Small-vessel involvement in TA and acute phase reactants should be taken into account for the diagnosis of an attack. In this report, treatment choices for four patients with the diagnosis of pediatric TA, their clinical and laboratory findings and their responses to treatment will be discussed.
  2 2,898 378
Assay of urinary protein-bound sialic acid can differentiate steroidsensitive nephrotic syndrome from steroid-resistant cases
Niranjan Gopal, Bidhan Chandra Koner, Atanu Bhattacharjee, Vishnu Bhat
January-February 2016, 27(1):37-40
DOI:10.4103/1319-2442.174066  PMID:26787564
The protein selectivity index as measured from the ratio of urinary immunoglobulin to albumin failed to differentiate between steroid-sensitive (SS) and steroid-resistant (SR) cases of nephrotic syndrome (NS). Sialic acid contributes negative charges to many plasma proteins. The negative charge is a determinant of protein excretion rate. The prognostic significance of assay of urinary excretion of protein-bound sialic acid in NS has not been evaluated. Hence, the present study was designed to evaluate whether measurement of urinary protein bound sialic acid (UPBSA) can be used as a marker to differentiate SS from SR cases of NS. The urine samples of 70 (47 SS and 23 SR) pediatric NS children were assayed for UPBSA by Aminoff's method. The levels were compared and the receiver-operator curve was drawn to determine the optimum cutoff point to differentiate among the groups before starting the therapy. The excretion of UPBSA in SR cases of NS was significantly higher than that of SS cases (P<0.05). The optimum cutoff limit for UPBSA was 2.71 μg/mg of proteins with 75% sensitivity and 75.5% specificity for differentiating SS cases from SR cases (area under the plasma- concentration time curve = 0.814, P = 0.009). We conclude that UPBSA can differentiate SR cases from SS cases of NS in pediatric patients and may help in predicting the response to steroid therapy.
  2 2,644 396
Attention deficit hyperactivity disorder in children with primary monosymptomatic nocturnal enuresis: A case-control study
Parsa Yousefichaijan, Mojtaba Sharafkhah, Bahman Salehi, Mohammad Rafiei
January-February 2016, 27(1):73-80
DOI:10.4103/1319-2442.174077  PMID:26787570
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood neurological disorders. The aim of this study was to investigate ADHD in children with primary monosymptomatic nocturnal enuresis (PMNE) and compare it with healthy children. A total of 100 five to 16-year-old children with PMNE and 100 healthy children without NE were included in this case-control study as the cases and control groups, respectively. Subjects were selected from children who were referred to the pediatric clinic of the Amir Kabir Hospital of Arak, Iran, based on inclusion and exclusion criteria. ADHD was diagnosed by Conner's Parent Rating Scale-48 and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria and was confirmed by consultation with a psychiatrist. Data were analyzed by binomial test using SPSS18. ADHD inattentive type was observed in 16 cases (16%) with PMNE and five controls (5%) (P = 0.01). Despite these significant differences in the case and control groups, 25 (25%) and 16 (16%) children were affected by ADHD hyperactive-impulsive type (P = 0.08) and 15 (15%) and 16 (16%) children were affected by ADHD mixed type (P = 0.84), respectively. ADHD inattentive type in children with PMNE was significantly more common than that in healthy children. The observed correlation between ADHD inattentive type and PMNE makes psychological counseling mandatory in children with PMNE.
  2 4,469 635
Plasma neutrophil gelatinase-associated lipocalin as a marker for the prediction of worsening renal function in children hospitalized for acute heart failure
Sahar Elsharawy, Lila Raslan, Saed Morsy, Basheir Hassan, Naglaa Khalifa
January-February 2016, 27(1):49-54
DOI:10.4103/1319-2442.174071  PMID:26787566
Acute heart failure (AHF) is frequently associated with worsening renal function in adult patients. Neutrophil gelatinase-associated lipocalin (NGAL) serves as an early marker for acute renal tubular injury. To assess the role of plasma NGAL in predicting worsening renal function (WRF) in children with AHF, we studied 30 children hospitalized for AHF; children with history of chronic renal disease or on nephrotoxic drugs were excluded. Twenty ageand sex-matched healthy children were included in the study as a control group. Echocardiographic examination was performed on admission. Blood urea nitrogen (BUN), serum creatinine, estimated glomerular filtration rate (eGFR) and plasma NGAL levels were measured on admission and 72 h later. Seventeen (56.6%) patients developed WRF within the three-day follow-up period. At presentation, plasma NGAL level was significantly elevated in children who developed WRF. Admission plasma NGAL level correlated with renal parameters (BUN, creatinine and eGFR) as well as with left ventricular systolic parameters (ejection fraction and fractional shortening). For prediction of WRF, admission plasma, NGAL level >27.5μg/L had sensitivity and specificity of 90% and 68%, respectively. The area under the receiver-operator curve was higher for NGAL (0.869) than for BUN (0.569) or eGFR (0.684). We conclude that admission plasma NGAL level can predict WRF in children hospitalized for AHF.
  2 3,081 484
Prevalence and clinical and laboratory characteristics of kidney disease in anti-retroviral-naive human immunodeficiency virus-infected patients in South-South Nigeria
UH Okafor, EI Unuigbe, E Chukwuonye
January-February 2016, 27(1):129-134
DOI:10.4103/1319-2442.174155  PMID:26787579
Since the emergence of acquired immune deficiency syndrome (AIDS) about three decades ago, several renal disorders have been reported as common complications of human immunodeficiency virus (HIV) infection. These renal disorders result from diverse etiologies. The aim of this cross-sectional study was to determine the prevalence and clinical and laboratory characteristics of anti-retroviral-naοve HIV-infected patients with impaired kidney disorder in South-South Nigeria. This study was conducted on patients presenting at the University of Benin Teaching Hospital, Benin City in South-South Nigeria for six months. The patients' demographic data and clinical, hematological and biochemical parameters were assessed. Their glomerular filtration rate (GFR) was calculated and the protein excretion was assessed from the protein- creatinine ratio. Data were analyzed using statistical software program SPSS version 15.0. Threehundred and eighty-three patients with a mean age of 35.39 ± 8.78 years and a male: female ratio of 1:1 were studied; 53.3% had evidence of kidney disorder. The main clinical features in patients with kidney disorder were evidence of fluid retention, urinary symptoms, pallor and encephalopathy. The mean systolic and diastolic blood pressures were 115.33 ± 17.17 and 72.33 ± 14.31 mm Hg, respectively. The mean estimated GFR was 52.5 mL/min/1.73 m 2 . Patients with kidney disorder had higher proteinuria (P = 0.001), lower mean CD4 cell count and packed cell volume (P = 0.019 and 0.001, respectively). Kidney disorder is a common complication in HIV-infected patients, and they have clinical and laboratory anomalies. Screening of HIV/AIDS patients at the time of diagnosis will facilitate early diagnosis of kidney disorders in them.
  2 3,338 380
Chromophobe renal cell carcinoma occurring in the renal allograft of a transplant recipient presenting with weight loss
Mohammed Mahdi Althaf, Mohammed S Al-Sunaid, Mohamed Said Abdelsalam, Lutfi A Alkorbi, Turki O Al-Hussain, Mohammed Anas Dababo, Naveed Haq
January-February 2016, 27(1):139-143
DOI:10.4103/1319-2442.174165  PMID:26787581
The incidence of renal cell carcinomas (RCCs) in renal transplant recipients is reported as 1.1-1.5% in the native kidneys and 0.22-0.25% in the renal allograft. There are no data to support routine surveillance for tumors in transplant recipients. Most reported cases of RCCs occurring in renal allografts were incidental findings in asymptomatic patients. Herein, we report the second case of lone chromophobe RCC (ChRCC) of the renal allograft presenting with weight loss. Loss of weight is a presenting symptom in one-third of ChRCCs occurring in the native kidneys in the general population. Based on the age of the patient, R.E.N.A.L nephrometry score of the tumor and the lack of data on the prognosis of this histological subtype in a climate of long-term immunosuppression, we elected for radical nephrectomy. We suggest that RCCs should be considered in the differential diagnosis of a transplant recipient presenting with weight loss even in the absence of localizing symptoms or signs.
  1 3,314 332
Malignant hypertension-associated thrombotic microangiopathy following cocaine use
Rais Lamia, Zohra El Ati, Lilia Ben Fatma, Karim Zouaghi, Wided Smaoui, Khedher Rania, Madiha Krid, Fathi Ben Hmida, Soumaya Béji, Fatma Ben Moussa
January-February 2016, 27(1):153-156
DOI:10.4103/1319-2442.174195  PMID:26787585
Cocaine is one of the most commonly used illicit drugs with distribution and consumption throughout the world. Acute renal failure associated with rhabdomyolysis, direct vasoconstriction and hemodynamic alteration is well described in patients with cocaine intoxication. Cocaine use is associated with high blood pressure and may rarely induce malignant hypertension associated with thrombotic microangiopathy. We report the case of a patient who developed malignant hypertension associated with thrombotic microangiopathy after chronic consumption of cocaine. A kidney biopsy revealed thrombotic microangiopathy with fibrinoid necrosis of arterioles and glomerular tufts. He required dialysis sessions. Cocaine-mediated endothelial injury and platelet activation may play important pathogenetic roles in cocaine abusers who develop malignant hypertension associated with thrombotic microangiopathy. Clinicians need to be aware of this rare feature of cocaine intoxication.
  1 3,768 639
Use of high-dose prednisolone to overcome rifampicin-induced corticosteroid non-responsiveness in childhood nephrotic syndrome
H Barman, R Dass, SG Duwarah
January-February 2016, 27(1):157-160
DOI:10.4103/1319-2442.174198  PMID:26787586
Inducing remission in nephrotic children on anti-tubercular therapy is difficult due to the increased metabolism of prednisolone induced by rifampicin. We report a child with nephrotic syndrome treated successfully with an increased dose of steroids without discontinuing anti-tubercular therapy.
  1 7,159 500
Severe forms of aspergillosis in patients on hemodialysis
M Jabrane, D Skandour, Y Rochdi, H Nouri, L Aderdour, A Raji, C Alaoui, W Fadili, I Laouad
January-February 2016, 27(1):174-176
DOI:10.4103/1319-2442.174208  PMID:26787591
  1 2,377 269
The relationship between malnutrition subgroups and volume parameters in pre-dialysis patients
Dilek Aslan Kutsal, Seyhun Kürşat, Ayça İnci, Cevval Ulman, I Ozan Ütük
January-February 2016, 27(1):81-87
DOI:10.4103/1319-2442.174082  PMID:26787571
There are two types of malnutrition in patients with chronic renal failure (CRF); type 1 and type 2. The aim of this study was to investigate the relationship between malnutrition and inflammation and also the relationship between malnutrition and volume status. Ninety-four pre-dialysis CRF patients were included in the study. Nutritional status of the patients was calculated using the subjective global assessment. Scores of 1-5 were given according to the severity of the symptoms and physical examination findings. Serum inflammation markers [high-sensitive C-reactive protein (hs-CRP), interleukin-1β, interleukin-6 and tumor necrosis factor-alfa] and nutrition parameters (albumin, pre-albumin, transferrin, fetuin-A, insulin like growth factor-1 and insulin-like growth factor-binding protein-3)] were measured in all the patients. Serum N-terminal pro-brain natriuretic peptide levels and echocardiography were performed to evaluate the volume status of the patients. The mean age of the patients was 59.6 ± 13.3 years, the mean malnutrition score was 17.2 ± 6.01, the mean and the median of hs-CRP levels were 18.5 ± 40.7 and 5.6 mg/L, respectively, the mean albumin level was 3.46 ± 0.48 and the mean creatinine clearance was 23.7 ± 13.5 mL/min. A positive correlation between malnutrition scores with inflammation and volume parameters was found in the bivariate and multivariate analysis. In the multiple regression analysis, volume parameters proved to be the most important factors influencing malnutrition scores. Thus, the elimination of volume excess would ameliorate both inflammation and malnutrition. This hypothesis needs to be supported or proved with prospective studies.
  1 3,346 553
Ethical and legal issues in renal transplantation in Nigeria
SO Ajayi, Y Raji, BL Salako
January-February 2016, 27(1):125-128
DOI:10.4103/1319-2442.174146  PMID:26787578
With the increasing number of patients being offered kidney transplantation by many centers in the developing world, it is not unexpected that there would be attendant ethical and legal issues even when the selection process for transplantation seems medically justified. Because of the inadequate infrastructure for hemodialysis and peritoneal dialysis, coupled with the challenges of logistics for maintenance dialysis, transplantation would seem to be the best option for patients with end-stage renal failure, even in developed economies where these can easily be tackled. The main issues here revolve around incentives for donors, organ trade and trafficking and the economics of eliminating the waiting list and the criminal activities of organ trans-plantation. In the developing world, with the current level of corruption and poverty, there is a need to redouble efforts to monitor transplant activities. Professional bodies should take the lead in this regard. Furthermore, there is a need for governments to engage in public consultation and community awareness concerning organ donation in living and deceased persons.
  1 6,463 663
Effect of pediatric liver transplantation on renal function
Hasan M.A. Isa, Afaf M Mohamed, Amer E Alderazi
January-February 2016, 27(1):1-8
DOI:10.4103/1319-2442.174041  PMID:26787559
The aim of this review is to define the incidence of renal dysfunction among pediatric liver transplant (LT) survivors, to identify the associated risk factors and to outline the therapeutic options. Renal dysfunction is a common problem after pediatric LT. The measured glomerular filtration rate is considered the "gold-standard" for assessment of renal function. Renal dysfunction in pediatric LT recipients is multifactorial. Renal-sparing immunosuppressive strategies are essential to reverse renal dysfunction and to prevent end-stage renal disease.
  1 3,592 692
Evaluation of administration of oral N-acetylcysteine to reduce oxidative stress in chronic hemodialysis patients: A double-blind, randomized, controlled clinical trial
Heshmatollah Shahbazian, Shokouh Shayanpour, Ali Ghorbani
January-February 2016, 27(1):88-93
DOI:10.4103/1319-2442.174084  PMID:26787572
This study was designed to assess the efficacy of N-acetylcysteine (NAC) on the reduction of oxidative stress in chronic hemodialysis (HD) patients through measurement of total serum anti-oxidant capacity. In this randomized, double-blind, controlled clinical trial, the efficacy and safety of NAC in reduction of oxidative stress was evaluated in 40 chronic HD patients. The study was conducted at the HD Department of the Golestan Hospital, Ahvaz, Iran. Data were analyzed using SPSS version 19. Paired samples test showed that the mean score of the serum level of total anti-oxidant capacity (TAC) increased from 26.39 ± 17.03 to 33.26 ± 18.8 (Pvalue = 0.01) and from 24.02 ± 16.47 to 25.38 ± 17.04 (P = 0.1) in the NAC and placebo groups, respectively. Difference in the mean TAC changes between groups was statistically significant (P= 0.042). In our study, NAC administration could reduce oxidative stress in chronic HD patients. No major side-effects were observed.
  - 6,073 850
Recurrence of nephrotic syndrome following kidney transplantation in a child with congenital nephrotic syndrome
Ali Derakhshan, Dorna Derakhshan, Mohammad Hossein Fallahzadeh, Mitra Basiratnia
January-February 2016, 27(1):150-152
DOI:10.4103/1319-2442.174192  PMID:26787584
Recurrence of original disease is a common threat in the field of transplantation. Recurrence of nephrotic syndrome is not common in children with congenital nephrotic syndrome (CNS). We report a case of a female child with CNS who presented with nephrotic state at first month of age and became dialysis dependent at 17 months of age. After seven months of continuous ambulatory peritoneal dialysis, she received a kidney from a deceased donor. Eight months after transplantation, she presented with a full-blown feature of nephrotic syndrome. She responded well to rituximab.
  - 3,342 492
Unusual presentation of tuberculosis in the form of a bilateral renal pseudotumor
Sanjeet Kumar Singh, Anjana Singh, Anant Kumar
January-February 2016, 27(1):161-163
DOI:10.4103/1319-2442.174201  PMID:26787587
Genitourinary tuberculosis (TB) is a common form of extrapulmonary tuberculosis. The kidneys are usually affected by hematogenous seeding at the time of primary pulmonary infection. Genitourinary TB has non-specific clinical presentations and variable radiographic appearances. We are reporting a case of genitourinary TB presenting as bilateral renal mass. The patient underwent computed tomography-guided kidney biopsy that showed a granulomatous lesion. Then, the patient was put on anti-tuberculous treatment with a good response. We feel that patients having multiple bilateral kidney lesions should undergo biopsy to determine the nature of the lesion before any surgical intervention.
  - 2,768 359
Mandibular mass in a child on hemodialysis
Doaa M Youssef, Faten F Mohammed, Tamer Adham
January-February 2016, 27(1):144-146
DOI:10.4103/1319-2442.174169  PMID:26787582
We here with report a 13-year-old female patient on regular hemodialysis for the past five years who presented with a large mandibular mass. This was detected to be a brown tumor due to severe renal osteodystrophy as a complication of secondary hyperparathyroidism. The tumor did not regress even with intensive treatment with intravenous active vitamin D and needed surgical removal.
  - 2,884 347
Multiple intracranial tuberculomas in a post-kidney transplant patient
Davood Yadegarynia, Muayad A Merza, Shahnaz Sali, Zahra Sadat Seghatoleslami
January-February 2016, 27(1):135-138
DOI:10.4103/1319-2442.174163  PMID:26787580
Tuberculosis (TB) is a serious public health problem worldwide, particularly in developing countries. The most common presentation of TB is the pulmonary form; however, extrapulmonary manifestations are not uncommon, particularly in the immunocompromised patients. TB of the central nervous system is the most severe extrapulmonary presentation. We report a post-kidney transplant patient who had multiple ring-like lesions on contrast-enhanced magnetic resonance imaging (MRI). Based on the results of MRI and biopsy specimen, the patient was diagnosed with multiple intracranial tuberculomas. He was treated successfully with a standard quadruple therapy of rifampicin, isoniazid, ethambutol and pyrazinamide.
  - 2,994 363
An unusual case of urinary incontinence in a post-renal transplant patient
Rajesh Kumar, Mohit Mathur, Rajesh Garsa, Dhananjai Agarwal, Vinay Malhotra, SS Yadav, Vinay Tomar
January-February 2016, 27(1):170-171
DOI:10.4103/1319-2442.174206  PMID:26787589
  - 3,501 256
Renal transplantation erythrocytosis among recipients of kidney transplantation of Afro-Arab origin patients
Elsharif Mohamed Elhafiz, Shawgi Abu Obeida Ahmed Abu Alga, Abd Allah Abd Elkareem Gibreel
January-February 2016, 27(1):172-173
DOI:10.4103/1319-2442.174207  PMID:26787590
  - 2,274 278
Nephrotic syndrome and situs inversus - A chance association?
Vaishali B More, Amit Saxena, Ratna Sharma
January-February 2016, 27(1):177-178
DOI:10.4103/1319-2442.174215  PMID:26787592
  - 2,343 269
Muehrcke's line
Rajesh Kumar, Amith V. L. D' Souza, Vinay Malhotra
January-February 2016, 27(1):179-180
DOI:10.4103/1319-2442.174218  PMID:26787593
  - 2,706 270
National survey of the availability and use of urine microscopy in the United Kingdom
Shafi Malik, Stuart Robertson
January-February 2016, 27(1):181-182
DOI:10.4103/1319-2442.174221  PMID:26787594
  - 1,984 219
How are families taught to look after their children on peritoneal dialysis?
Reem S Alhameedi, Jacqueline Collier
January-February 2016, 27(1):29-36
DOI:10.4103/1319-2442.174065  PMID:26787563
For patients to be started on peritoneal dialysis (PD), they need to be trained on how to perform dialysis at home. Understanding how to carry out dialysis is difficult for adults, but perhaps even more challenging for parents of children. This study was performed to examine the PD teaching programs for parents of children with end-stage renal disease (ESRD) and to explore the issues related to educating parents of children with ESRD. A survey method was used to carry out the research through the distribution of self-completed questionnaires to pediatric dialysis units (ten units) in Saudi Arabia in both governmental and non-governmental hospitals. The questionnaire content was identified using information gained from other research performed in the field of home PD training. The questionnaire was piloted with experienced renal nurses. Questionnaires were distributed to 87 specialized nurses within the ten PD units. Descriptive statistical analysis SPSS (19.00) was used to analyze the data. Statistical tests were used to distinguish the relationship and the significant effects between variables. The response rate was 72% (n = 63). Peritonitis rates varied in each hospital, and ranged from zero to three episodes per patient-year (median 1.17 episodes per patient-year). There was a significant association between home visits and peritonitis rates (P <0.01). This study has provided an initial overview of pediatric PD training programs in Saudi Arabia and has provided valuable data in this regard.
  - 3,309 501
Multiple myeloma: Diagnosis and management issues in patients with pre-existing chronic kidney disease
Srilatha Vadlamudi, Siva Nagendra Reddy Annapareddy
January-February 2016, 27(1):9-14
DOI:10.4103/1319-2442.174046  PMID:26787560
Multiple myeloma is one of the most common malignancies encountered in clinical practice. Renal involvement in myeloma is a well-recognized entity. Although rare, another special situation that a nephrologist can encounter is myeloma occurring in a patient with preexisting chronic kidney disease (CKD) due to other etiologies. Anemia, bone pains and hypercalcemia, which commonly indicate the diagnosis of myeloma in the general population, are not useful in the presence of CKD. The sensitivity and specificity of serum free light chain assay is decreased in the presence of renal failure. Chemotherapy-related adverse effects are high compared with that in patients without CKD; this is attributed to the decreased clearance of drugs and the additive effect of chemotherapy-related adverse effects to the complications of CKD. Autologous and allogenic bone marrow transplantation can be attempted in this group of patients with non-myeloablative-conditioning regimens. Combined bone marrow and renal transplantation remains a viable option in this group of patients to increase life expectancy and quality of life.
  - 9,897 1,330
Health indicators for renal replacement therapy in Saudi Arabia

January-February 2016, 27(1):183-189
  - 1,347 185
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